S3) Lymphatic Drainage of the Head and Neck Flashcards

1
Q

What does the lymphatic system consist of?

A
  • Lymph nodes
  • Lymphatics
  • Lymph fluid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the purpose of the lympathic system?

A

Continuous removal of residual tissue fluid from the extracellular space (via a series of lymph nodes) to be returned back to blood circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Lymph is just tissue fluid which has entered the lymphatic capillary.

Identify some of the contents of lymph

A
  • Lipids (chylomicrons from gut lymphatics)
  • Small proteins
  • Damaged cells
  • Tissue fluid
  • Bacteria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How much lymph does the body produce a day?

A

3 ‐ 4 L of lymphatic fluid produced per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What danger is associated with the lymphatic vessels?

A

A route for the spread of infection and malignant disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Illustrate how uni-directional flow occurs in the lymphatic system

A

Tissue fluid → lympathic capillary → lymphatic vessels → lymphatic nodes → lymphatic vessels → lymphatic trunks → lymphatic ducts → venous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The lymphatic system is a low pressure system with no central pump.

How does the lymph flow?

A
  • Valves: passive and intrinsic constriction
  • Pulsation of an artery (close association)
  • Muscle contraction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where in the venous circulation does the lymph drain?

A

Lymphatic system ends in two main lymphatic ducts which drain into subclavian veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is lymphoedema?

A

Lymphoedema is the abnormal collection of protein‐rich fluid causing tissue swelling due to compromised lymphatic system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lymphoedema is a chronic condition.

Identify 5 of its causes

A
  • Removal / enlargement of lymph nodes
  • Infections e.g. certain parasites
  • Damage to lymphatic system e.g. cancer treatments
  • Lack of limb movement
  • Congenital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Provide 3 examples of lymphoid organs in the body

A
  • Spleen
  • Tonsils (Waldeyer’s ring)
  • Thymus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the structure of lymph nodes

A

Connective tissue structures:

  • Tough fibrous outer capsule
  • Reticular connective tissue inside
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe, briefly, how lymph nodes provide defence against infection

A
  • Physical filter
  • Phagocytic filter
  • Lymphocytes: activate and proliferate in response to antigens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Enlarged lymph nodes is a very common patient presentation.

Which two underlying conditions cause this?

A

Lymphadenopathy:

  • Infection – most common, tender, mobile
  • Cancer – hard, matted, non-tender
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What should one do when a patient presents with enlarged lymph nodes?

A
  • Comprehensive history
  • Examine the area of tissue it drains
  • Examine other lymph nodes and body systems (if malignancy is suspected)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lymph nodes in the head and neck can be classified into two groups.

Identify them and describe their function

A
  • Regional: receive drainage from scalp, face and neck (ring)
  • Terminal: receive drainage from regional nodes (vertical)
17
Q

Describe the relative depth of terminal and regional lymph nodes

A
  • Regional = superficial
  • Terminal = deep
18
Q

Identify the 5 regions in body where collections of lymph nodes may be palpable

A
19
Q

How many lymph nodes are in the body?

Of those, how many can be found in the neck?

A
  • 800 lymph nodes in the body
  • 300 lymph nodes in the neck
20
Q

Where are regional lymph nodes located?

A

Superficial to the investing layer of deep cervical fascia

21
Q

Where are the terminal lymph nodes located?

A
  • Deep to the investing layer of deep cervical fascia
  • Most are associated with IJV (in carotid sheath)
22
Q

Identify the following superficial lymph nodes 1-5:

A

1) Submental
2) Submandibular
3) Pre-auricular
4) Post-auricular
5) Occipital

23
Q

Identify the following cervical lymph nodes 6-8:

A

6) Superficial: EJV
7) Posterior: EJV
8) Anterior: AJV

24
Q

Identify the following deep lymph nodes 9-11:

A

9) Jugulo‐digastric (tonsillar node)
10) Jugulo‐omohyoid
11) Supraclavicular lymph nodes

25
Q

What do supraclavicular lymph nodes do?

A

Supraclavicular lymph nodes oversee transport of lymph from thoracic cavity and abdomen

26
Q

Where are supraclavicular lymph nodes located?

A

Supraclavicular nodes are found in the root of the neck on either side

27
Q

What is Virchow’s node?

A

Virchow’s node is a lymph node in the left supraclavicular fossa

28
Q

What is Trosier’s sign?

A

Trosier’s sign is the enlargement of the left supraclavicular node (Virchow’s node) secondary to metastatic abdominal malignancy

29
Q

Where is the jugulo-digastric node located and what does it do?

A

The jugulo-digastric node is located just below and behind the angle of the mandible and is concerned with lymph drainage of the palatine tonsil, oral cavity and the tongue

30
Q

What does the jugolo-omohyoid lymph node do?

A

The jugulo-omohyoid node is mainly associated with the lymph drainage of the tongue, oral cavity, trachea, oesophagus and the thyroid gland

31
Q

Where do deep lymph nodes drain?

A

Deep cervical lymph nodes eventually drain via the thoracic duct (or right lymphatic duct) into the subclavian vein

32
Q

The deep lymphatic vessels converge to form left and right jugular lymphatic trunks.

Describe their location

A
  • Left jugular lymphatic trunk: joins thoracic duct at root of neck
  • Right jugular lymphatic trunk: empties into right lymphatic duct at root of neck
33
Q

Why do some diseases involve both regional and terminal cervical lymph nodes?

A

Many structures of the head and neck drain via superficial lymph nodes into the deep cervical lymph nodes

34
Q

What is Waldeyer’s ring?

A

Waldeyer’s ring is an annular collection of lymphatic tissue (nodules) surrounding the entrance to the aerodigestive tracts

35
Q

Identify the tonsils which form Waldeyer’s ring

A
  • Lingual tonsil
  • Palatine tonsils
  • Tubal tonsils
  • Pharyngeal tonsils
36
Q

Which tonsils are affected by tonsillitis?

A

Palatine tonsils

37
Q

Which of the lymphoid tissue in Waldeyer’s ring can one most readily view when examining a patient?

A

Palatine tonsils

38
Q

Which tonsils of Waldeyer’s ring are also called the adenoids?

Where are they located?

A

Pharyngeal tonsils – located in the roof of the nasopharynx (behind the uvula)

39
Q

Why might an enlargement of the adenoids cause middle ear problems?

A
  • An enlarged adenoid can block the Eustachian tube
  • Mucus cannot drain properly and accumulates
  • Infection easily spreads into middle ear